If climbing into a tub to take a shower is a perilous activity, installing a low-threshold shower is a sensible preventative measure to reduce injuries as these VA before and after photos illustrate. Clearly the cost of such alterations is prohibitive for many folks.

The program’s goal is “…to provide monetary benefits for improvements and structural alterations to the homes of eligible veterans or servicemembers that are necessary for the continuation of the provision of home health treatment of the beneficiary’s disability or that provide access to the beneficiary’s home or to essential lavatory and sanitary facilities in the home.”

Home improvement benefits up to $6,800 may be provided for a:

service-connected condition

non-service-connected condition of a Veteran rated 50 percent or more service-connected

Home improvement benefits up to $2,000 may be provided to all other Veterans registered in the VA health care system

This program is described in Federal Register Volume 78, Issue 224 (November 20, 2013) Proposed Rules (pages 69614-69625 ) here–some of which actually make sense. This little VHA video makes it sounds so easy and pleasant, doesn’t it? Until you check out the BVA claims online. For example, BVA denial #1436932. The vet just needed/wanted a new front porch with railings (he had none). In the midst of wrangling with the VA, he had one built, and wanted reimbursement. His mistakes: he didn’t get prior authorization, had no medical emergency for an exception (see VHA Handbook 1173.14, para. 10 (i)).,used the DAV, but his fatal flaw was that he didn’t want a wheelchair ramp that the VA OT insisted he get because # 1) the vet said he didn’t want his house to look like a “dump” and #2) he used a walker (and cane) not a wheelchair. Like a true ornery Yankee, he refused the proffered ramp. For his perceived ingratitude, VLJ John J. Crowley decided to chastise him like a little child:

In response to statements such as this one that appear throughout the record, the Board reminds the Veteran that HSIA benefits are medical in nature, designed to, in a case such as this one, assure that veterans have safe access to their residences. It is a misunderstanding of the purpose of the law to view such benefits as aesthetic or decorative in nature. In any event, a ramp would also not have necessary made his home unsightly and may, if fact, have been better for the Veteran’s ambulation in the long term.

And even though the judge caught the Manchester VAMC in a lie, he let it slide.

On July 19, 2012, it was noted that the Veteran needed a stair railing and ramp to the front door. On that day, the VAMC’s MajorMedical Committee (MMC) met to evaluate the request for a HISA grant. The committee denied a HISA grant for remodeling because the remodeling project was already well underway. [The Board notes, however, that the facts suggest that renovations to the front porch and hand railings were not, in fact, “well underway” or even begun at this point.]

The way this case is written is odd; the veteran served from 1953-1955 but in what military branch, or where, the judge is mute. In any case, the VA didn’t give him the benefit of doubt, engaged in a pissing contest with an eligible disabled (100%) deaf elder veteran and made some nasty insinuations about his character and habits. A pox on them!

9 Responses to VHA’s Home Improvements and Structural Alterations (HISA)

The thing is I am 100% Disabled with Aid and Attendance at the “M” rate and waiting for the past 6 years on my appeal to be heard for a higher rating. I submitted for a HISA grant and what they sent me would be literally impossible for me to complete. It is an exhaustive packet of information that only a person who is not disabled can accomplish and to put the restrictions on the companies that would do business with the VA is restrictive to say the least. My HISA grant is heard through the prosthetics department and when I told them I could not walk or get out of bed they offered no help whatsoever so it is out of the question for me and no I don’t have anyone to help me and I need wood flooring badly so I can use my electric wheelchair in the house. It is truly pathetic and Prosthetics Department at the Fayetteville, Ark. VA Hosp are really rude.

I could really use a walk-in shower. I am bound to fall getting into by tub-shower and bust my ass (hip) one of these days. I have PN in my feet which makes me clumsy at times. I take meds that make me tipsey. So I think I may put in for this product/service. I am total plus 80% with housebound “S”.

I’ve looked at some HISA denials and the main ones seem to be with not getting prior authorization or a vet asking for something that falls into the “comfort” category but not medically necessary. This is a medical grant administered by the VHA and VAMC so a VA doc. or private doc will prescribe this and VA OT might be involved. If you have a chapter of the Paralyzed Veterans of America in your state, they could probably assist you since they are the most experienced with mobility.http://www.pva.org/site/c.ajIRK9NJLcJ2E/b.6452325/k.A0ED/Chapters_and_NSOs.htm
Read the form’s certification carefully. Read the Handbook (linked to in post).http://www.prosthetics.va.gov/docs/vha-10-0103-fill.pdf
But if you are in serious danger of falling due to your medical conditions this is worth looking into. Let us know what you discover and how it goes. Stay safe and good luck.

When I approached the VA about an ILP service the rep told me that they would seek a HISA grant to pay for it. Still not understanding that thought process as the ILP is funded by Congress via the DVA. I checked into the cost of one of those walk-in tubs and was quoted an astronomical amount of $7.000.00. When I told the salesperson that I could get the area ready for installation he balked and said that they had to do the tearout and remodeling of the opening. Too bad for them that I have 27 years experience in the construction field to back me up. Funny how they never even said thank you for your interest in our product.

It’s possible that they have private contractors in your who are already registered with the VA (for payment) who will stay within the limits. I was interested to see that the Manchester committee actually contacted a contractor (EZ Access) for a wheelchair ramp for him:

“A ramp to the front door of the home was approved. On July 20, 2012, a request was sent to EZ Access to assess the home for a wheelchair ramp. On July 23, 2012, a message from EZ Access to VA indicated that the Veteran had refused a wheelchair ramp. The Veteran indicated that he simply wanted his walkway replaced.”

Drats!!!! Well, you might have a medical access need for something else in the future that’s covered. If you read the handbook VHA 1173.14 (its short) and the new regs; and read up on the denials/grants with the search term, “Home Improvements and Structural Improvements (HISA) to learn more; you might be eligible for something else. They really don’t do much in the way of outreach, do they? I believe that this can be used in addition to other adaptive housing grants which aren’t under the VHA. Your local VAMC medical board would ultimately decide the request. It gets a little tricky with the way the contractors get paid. I think the rules have been liberalized though. Any approved cost over runs are the vets responsibility. But if the contractor goes bankrupt and doesn’t complete the job, the vet doesn’t have to pay the VA back. Something like that….Keeping vets safe at home with HISA, the telehealth program etc., local non-VA care, will all save money. Some people at VHA can think big.

I was reading through some old issues and stopped at the HISA grant blog and I can tell you from my experience that the main reason Vets get denied is that in asking their physician for a letter to go through Prosthetics Dept. they fail to Dick and Jane speak. In other words the doctor writes up the request stating that his patient would benefit in his back pain, neck issues, neuropathy etc. When in fact the terminology is all handed down from the Gods in DC and has to say, “would allow Mr./Mrs. Smith greater access to the facilities for personal hygiene with less reliance on others and thereby providing greater independence.” Anything other than that short wording and I can estimate your failure rate to be at least 95% and the VA has the authority to deny based upon the wording. As I said I speak from personal experience. I am now rated at 190% and I am still fighting for my walk-in tub and a Sleep Number bed. I have met some of the Neanderthals working here in Denver, CO and Lord help us all; They know nothing!!!!!!!!
Anyhow, going back at them and heading towards the BVA where a more common sense individual(s) can decide the issue along with my attorney. Will keep in touch.